Sussex Rehabilitation Centre, Brighton

“the assessment may involve a very stringent interpretation of the Eligibility Criteria designed to minimise the outgoings of the Wheelchair Service” and that “local interpretation” results in a “postcode lottery” Hard Pushed (2004), Fully Equipped (2002)

Assessment Factors to Consider: Out and About (2006)

! ! ! ! ! Oh, did I mention he’s blind? Special Issues Panel Risk Assessment EPIC EPIOC

Snellen scoring Normal visual acuity is called 6/6 6m 6/60 6/18 6/24 6/36 6/12 6/9

Requirements No legal eyesight requirement for users driving Class 2 or 3 vehicles DVLA Guideline for Class 2 or 3 vehicles Read car number plate from 12.3m (40ft, 6/24?) and monitor Driving Requirements for car Read car number plate from 20m and min field of vision 120 o horizontal and 20 o vertical plane

Do services assess service users with visual impairments for EPIOC provision to see if they can compensate either independently or with support?

Variability of visual ability requirements which a service user would have to achieve in order to be considered eligible for EPIOC assessment

SUMMARY No legal eyesight requirement for users driving Class 2 or 3 vehicles This study highlights big discrepancies in eligibility criteria across the country Could be argued that service users with visual impairments are sometimes being discriminated against CONCLUSION Service users should be given the opportunity to show whether they can compensate Question all areas of your local eligibility criteria This study highlights the value of us all sharing our knowledge and how our services work

References Audit Commission (2002) Fully Epuipped Currie, Z., Bhan, A., Pepper I. (2000) Reliability of Snellen charts for testing visual acuity for driving: prospective study and postal questionnaire. BMJ 321: Department of Health (2006) Out and About Department of Transport (downloaded 14/01/2008) Code of Practice for Class 3 Vehicles. Directgov (2008) The Highway Code – 36-46: Rules for Users of Powered Wheelchair and Mobility Scooters. Drasdo, N., Haggerty, C. M. (2007) A Comparison of The British Number Plate and Snellen Vision Tests for Car Drivers Ophthalmic and Physiological Optics, Vol 1 Issue 1: Drivers Medical Group, DVLA (2007) For Medical Practitioners – At a glance Guide to the current Medical Standards of Fitness to Drive. DVLA Greenbaum et al (1998) Use of a Motorized Wheelchair in Conjunction With a Guide Dog for the legally Blind and Physically Disabled. Muscular Dystrophy Campaign (2004) Hard Pushed: How the NHS Fails Powered Wheelchair Users Think! Road Safety (downloaded 15/01/2008) THINK! Advice – Older drivers: drive on! Tim Carter (2006) Fitness to Drive: A Guide for Health Professionals. The Royal Society of Medicine Press Limited. RNIB (downloaded 10/12/2008) How does the eye consultant measure your sight? Statutory Instrument 1988 No Road Traffic. The Use of Invalid Carriages on Highway Regulations 1988.

Compensation Strategies Feedback from services on strategies they used to reduce risk and ensure safe : Ophthalmologist report can highlight specific areas an assessor needs to check to ensure adequate compensation. Supervision / assistance conditions in the conditions of loan Agree areas of use and restrictions outside these areas Test a user’s ability to avoid obstacles on a pathway (more applicable than number plate testing Grade the provision - EPIC first, then build up to an EPIOC Dual control so assistance can be given in unfamiliar areas Regular reviews for service users that have deteriorating vision Offer a training package to give users time to learn how to compensate Adjust EPIOC control programmes Discuss provision amongst colleagues and minute so provision decision is made by the service rather than the individual assessing professional Risk assess to check that service users are no a danger to themselves or others

Snellen to number plate conversions y z a b yz ab Number plate distance (pre 2001) Calculated Snellen score RCO stated equivalent Snellen score 20.5m6/156/ m6/ m9/ m6/ m3/60-

Snellen scoring Severely Sight Impaired (Blind) Acuity<3/60 full visual field 3/60<acuity<6/60 reduced visual field Acuity>6/60 very reduced visual field Sight Impaired (Partially Sighted) 3/60<acuity<6/60 full visual field Acuity<6/24 moderate visual field Acuity<6/18 severe reduced visual field 6/60 6/18 6/24